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Retained Sponges and Instruments

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What is a retained surgical instrument?

Although less well known than a surgery performed at the “wrong site”, retained surgical instruments is actually more common. Retained surgical instruments simply means that the surgeon forgot to remove needles, scalpels, clamps , sponges, etc after the completion of the surgery. This is supposed to be avoided by counting all instruments used during surgery and being sure they are all accounted for at the completion of surgery. They are also known as a retained foreign body.

What leads to a retained surgical instruments as a result of surgery?

Retained surgical instruments (needles, scalpels, clamps , sponges, etc ) occurs due to poor counting systems, fatigue of one or more members of the surgical team, difficult operations, or sponges “sticking together”. The following practices were developed by the AORN Recommended Practices Committee and are effective January 1, 2000:

Sponges should be counted on all procedures in which the possibility exists that a sponge could be retained. Sponge counts should be taken:

  1. Before the procedure to establish a baseline
  2. before closure of a cavity
  3. before wound closure begins
  4. at skin closure or end of procedure
  5. at the time of permanent relief of either the scrub person or the circulating nurse

 

What is the danger of a retained surgical instrument?

There are many dangers as a retained surgical instrument can results in infections or a fibrinous response which may require another surgery to remove the retained surgical instrument. The retained surgical instrument can cause local or systemic symptoms that can lead to major illness or death.

When do retained surgical instruments and sponges occur?

Medical errors during surgery are usually under-report and not well studied. One study reported that 55% of retained surgical sponges were found after abdominal surgery and 16% occur after vaginal delivery. The risk of a retained surgical instrument or sponge increases in emergency situation, with unplanned changes in procedures or in obese patients. A 2008 study indicated that 1 in 8 surgical cases involves an intraoperative discrepancy in the count of surgical sponges or instruments resulting in a retained sponge and instrument (RSI). Another 2008 study indicates they occur “more frequently than expected from literature”.

What is a retained surgical sponge?

Gossypiboma is the name given to a retained surgical sponge, pad, or towel (gossypium (Latin), cotton; + plboma (Swahili), place of concealment). It occurs when a surgical team fails to remove all surgical sponges, pads or towels from a patient.

Who is responsible for retained surgical sponges and retained surgical instruments?

The legal responsibility extends to the surgeon. In the case /Ravi v Williams/ (536 So2d 1374 [Ala 1988]), the Alabama Supreme Court, on the basis of “Captain of the Ship” Doctrine “...reasoned that the surgeon remains responsible for what he put in the patient’s abdomen, despite the fact that the general custom and practice...is to delegate the task of accounting for sponges to the OR nurses. The fact that the surgeon delegated the task of counting the sponges [to the nurses]...does not relieve the surgeon of the responsibility to remove them in the first place. The surgeon alone has the responsibility for removing all sponges”(7). Note: This doctrine may not be recognized in all jurisdictions.

The hospital where the surgery took place may have legal responsibility as well since it is often the case that operating room nurses employed by them must undertake sponge and needle counts and it may be their error which produces the mistake even more directly than the surgeon.

What are the legal ramifications of a retained surgical sponge or retained surgical instrument?

The legal term /res ipsa loquitur, /which is commonly translated “the thing speaks for itself” applies. In the case of a retained surgical sponge or instrument, there is such a strong inference of negligence that it is considered below the standard of care for surgery.

Why do I need an attorney?

Where law and medicine intersect, your lawyer stands in the breach. As a patient you want and need quality medical care and treatment, particularly for those injuries which are serious or may become so in the absence thereof. As a injured party seeking financial compensation along with a measure of justice, the importance of medical documentation is the primary tool which your lawyer may use to accomplish this.

Is Presettlement funding available?

Medical malpractice sometimes involves unique provisions of the law and procedure further complicated by the medical-legal issues present. Even where liability seems reasonably clear insurance companies obligated to pay damages on behalf of those they insure often vigorously defend such claims. As a result, there are some situations where presettlement funding may be appropriate to provide a vital lifeline in order to obtain important related medical care or to stay financially afloat. In most jurisdictions a lawyer may not ethically lend you money or pay your bills.

 

Here are some good links regarding retained sponges/insturments:

Article from the New England Journal of Medicine “Risk Factors for Retained Instruments and Sponges After Surgery”

US Department of Health and Human Services, Agency for Healthcare Research and Quality, Chapter 22. The Retained Surgical Sponge